Castleman tumor or disease is a rare condition and cluster of uncommon lymphoproliferative disorders that involve overgrowth of cells of lymph nodes with unique histological features on microscopic analysis. It is associated with cytokine – driven clinical features and biochemical disturbances. The unicentric Castleman disease is treatable with complete surgical removal, whereas multicentric Castleman disease is treated with treatment. The exact cause, pathophysiology, and prevention is unknown but HIV and HHV-8 is the risk factor. An alternate way of treatment involves herbal remedies which may help treat Castleman’s tumor-associated complications and side-effects. Many herbs are under clinical trials.
Castleman disease (CD) or Castleman tumor also known as Angiofollicular lymph node hyperplasia. It was first described and named after and described by Benjamin Castleman in 1954. He described a 40-year-old male person with Castleman disease having mass in mediastinum.CD is a heterogenous cluster of lymphoproliferative disorders that involves enlargement of lymph nodes. It includes 2 different subtypes of CD involving Unicentric Castleman disease (UCD) when only one lymph node region is affected, Multicentric Castleman disease (MCD) when more than one lymph node region is affected.
The fundamental roles of Human immunodeficiency virus (HIV), Human herpes virus-8 (HHV-8), interleukin -6 (IL-6) in the proportion of cases of CD. CD is not a form of cancer but it can cause lymphoma or another type of blood cancer. UCD is surgically manageable and MCD is treated therapeutically. Ayurvedic approach is based on herbal remedies.
AYURVEDIC CONCEPT OF CASTLEMAN TUMOUR
Castleman disease’s subtypes have common features in the lymph nodes, if seen under a microscope, vary in symptoms, pathology, and treatment.
There are two main established subtypes of Castleman’s disease:-
- Unicentric Castleman disease (UCD)
- Multicentric Castleman disease(MCD)
It can be
- Idiopathic multicentric Castleman disease(IMCD)
- Human herpesvirus -8 associated Castleman disease(HHV-8 associated MCD)
A. Unicentric Castleman disease (UCD)
- It is the most common subtype as compared to HHV-8 MCD and IMC.
- It is a type of Castleman disease in which single or more enlarged lymph nodes are located in one area of lymph nodes.
- In this type, discomfort is present due to the enlarged lymph node.
- It can involve systemic MCD symptoms sometimes but are milder typically.
- It does not transit into MCD.
- Organ failure is not common in UCD.
Its treatment of choice is the surgical removal of the enlarged lymph node. The majority of patients completely treated after surgical removal without getting any complications or relapse.
B. Multicentric Castleman disease(MCD)
- It is a type in which enlarged lymph nodes are located at multiple areas of lymph nodes.
- It involves a multi-organ system and can cause multi-organ failure due to systemic infection.
It is sub-divided into the following two types
a) -Idiopathic multicentric Castleman disease(IMCD)
- It is a type of MCD in which enlarged lymph nodes are located at multiple lymph node areas but its exact cause is unknown.
- It is less common than UCD.
- symptoms in IMCD are more severe as compared to the UCD.
- Surgery is not the treatment of choice in this type as it is ineffective. Medications are commonly used.
- Diagnosis is made based on laboratory investigations.
b) Human herpesvirus- 8 associated Castleman disease(HHV-8 associated ( MCD)
It is a type of MCD in which enlargement of lymph nodes is located at multiple areas of lymph node which occurs mainly due to human herpesvirus 8 infection.
- It is also less common than UCD.
- Patients infected with human
- immunodeficiency virus (HIV) frequently have
- HHV-8 associated MCD.
- It has symptoms and diagnostic findings similar to the IMCD.
It is also treated by using medications like IMCD, surgery is not effective in this.
Some patients have enlargement of lymph nodes associated with unicentric Castleman and others have multicentric Castleman. Thus some people having unicentric Castleman experiences clinical signs and symptoms which are common with multicentric Castleman, like:
- Feeling of fullness
In Multicentric Castleman tumor a wide range of symptoms can be there. These are commonly located in the neck region, Collarbone underarm and groin area,
- Mild to severe flu-like symptoms
- night sweats
- wasting and weakness of the body tissues
- numbness in hands and feet
- muscular atrophy
- unintended weight loss
- Cherry hemangiomas
- decreased urine output
- systemic toxicity (if kidney failure)
- systemic infection (if bone marrow failure)
- splenomegaly or hepatomegaly
It’s not clear what causes Castleman disease. However, infection by a virus called human herpesvirus 8 (HHV-8) is associated with multicentric Castleman disease,
The HHV-8 virus has also been linked to the development of Kaposi’s sarcoma, a cancerous tumor that can be a complication of HIV/AIDS. Studies have found that HHV-8 is present in nearly all HIV-positive people who have Castleman disease, and in about half of HIV-negative people with Castleman disease.
Castleman disease can affect people of any age. But the average age of people diagnosed with unicentric Castleman disease is 35. Most people with the multicentric form are in their 50s and 60s. The multicentric form is also slightly more common in men than in women.
The risk of developing multicentric Castleman disease is higher in people who are infected with a virus called human herpesvirus 8 (HHV-8).
CD people having UCD do not cause complications as this type of CD is treated effectively by surgical removal, whereas people with MCD usually lead to life-threatening conditions or organ failure.
Some complications are listed as follows
- Kaposi sarcoma or lymphoma ( increased risk with both types of CD)
- Renal failure
- Internal jugular vein thrombosis
- Septic embolic phenomena
- Carotid artery rupture
- Mediastinal abscess
- Purulent pericarditis
Diagnosis is made based on thorough physical examination and following investigations are done to diagnose Castleman disease and to know the effectiveness of treatment:-
1. Blood investigations
- Complete blood count for hemoglobin range, total leucocyte count, platelet count; blood proteins.
2. Urine Examination
- Urine routine and microscopic examination.
3. Medical imaging
- Computed tomography (CT scan )- of neck, chest, abdomen, and pelvis can be done based on the area involved
- Magnetic resonance imaging (MRI scan ) – of neck, chest, abdomen, and pelvis can be done based on the area involved
- Positron emission tomography (PET) scan
4) Lymph node biopsy
- It is usually done to differentiate Castleman tumors from other lymphatic tissue disorders like lymphoma.
HERBS FOR CASTLEMAN TUMOUR
Many plants and plant products have anti-cancer properties and have been recognized for centuries. Many herbs are under research for chemoprotective and anticarcinogenic properties and actions.
Some of the Herbs used are
1. Guduchi/giloy (Tinospora cordifolia ) – It is also known as ‘amrita’. Its stem is mainly used, but its roots also contain some potent alkaloids. It is a well-known herb in modern medicine for its adaptogenic, immunomodulatory and antioxidant properties.
2. Bhunima/kalmegh (Andrographis paniculata)– Its leaves and roots are used for medicinal properties. It is a potent hepatoprotective herb and stimulates the immune system. It is used as a chemoprotective agent because it can activate both antigen-specific and non-specific immune responses.
3.Mandukparni (Centella asiatica) – It is a herb having the potential for acting as an anticancer agent. It has a protective action against radiation-induced damage and oxidative damage.
4. Haridra (Curcuma longa)-It contains a main active ingredient named curcumin that can inhibit the proliferation of various tumor cells and interferes in cell cycle progression. It also can inhibit angiogenesis- associated genes
5. Bhumiamlaki (Phyllanthus niruri)-It is a herb possessing chemoprotective and hepatoprotective action. It can inhibit the metabolic activation of carcinogenic compounds and promotes the arresting of the cell cycle.
6. Ashwagandha (Withania somnifera)-Its root is used for medicinal properties and it has been used widely for its anti-oxidant, anti-peroxidative, immuno-modulatory, anti-tumor, thyro-regulatory, anti-stress, anti-aging and rejuvenating properties.
7. Kanchnaar (Bauhinia variegata) – It is the herb that is used in treating enlarged lymph nodes in any part of the body.
8. Dashmool – It contains 10 different herbs having beneficial medicinal properties. It has anti-inflammatory, analgesic, anti-oxidant properties.
9. Manjistha ( Rubia cordifolia )– Its root is used for the medicinal properties. It has anti-inflammatory, detoxifying action. It is useful in various skin disorders and lymphatic system-related diseases.
10. Shirish (Albizia lebbock)–Shirish possess anti-allergic, anti-histaminic, anti-inflammatory, anti-bacterial properties. It is helpful in allergic conditions, skin diseases, inflammation, snake-bite, respiratory conditions.
There are some herbal remedies beneficial in the Treatment of Castleman tumor recommended by Planet Ayurveda. It includes:
- Boswellia curcumin:- It is the herbal remedy prepared from Boswellia serrata and Curcuma longa. It has anti-inflammatory and analgesic properties.
- Pitta balance:- It is the polyherbal formulation that helps in balancing the pitta dosha of the body that is responsible for various ailments. It helps in maintaining an overall healthy body.
- Giloy capsules:- It contains pure and standardized extract of herb Giloy. It has anti-oxidant, antipyretic and immunomodulatory action.
- Kanchnaar guggul:– It is a polyherbal formulation containing kanchnaar bark and guggul as a main active ingredient. It helps control the overgrowth of cells in the body. It has anti-inflammatory action and widely used in glandular swelling, lymph node enlargement, thyroid disorders.
- Ashwagandha capsules:- It contains pure extract of ashwagandha root. It is a potent immunomodulator, anti-oxidant and thyroid function modulating agent.
- Immune booster:- It is a polyherbal formulation containing herbs having action on the immune system. It helps in building a healthy immune system and prevents from various infections.
HOME REMEDIES FOR CASTLE TUMOR
There are some home remedies too which helps in relieving various symptoms by using herbs or products available at home are:-
- Kanchnaar leaves can be used for preparing decoction, it is helpful in inflammation.
- Turmeric powder with milk is also a great anti-inflammatory remedy.
- Punarnava decoction can be used in excessive edema, ascites condition. 5gm punarnava powder 400 ml of water is used to prepare a decoction.
- Giloy stem is dipped overnight in water and morning water is strained and drink it for relieving fever.
DIET AND LIFESTYLE CHANGES
Diet changes include
- Always eat organic fresh fruits and vegetables.
- Increased intake of water.
- >3. Avoid eating all bakery products and maida.
- Avoid junk or deep-fried food, packed food, ready to eat food.
- As per the advice of vaidyas Fasting once a week is good for health.
- Decrease intake of sugar – it includes jaggery, honey, fruit juices, white/brown sugar, beetroot juice.
- Don’t eat raw salad or food when chemotherapy is ongoing.
- Avoid eating after 7 pm.
LIFESTYLE CHANGES INCLUDE
- Maintain healthy body weight.
- Make a habit of daily exercise, walk, yoga.
- Massaging and meditation are good for both physical mental wellness.
- Avoid the intake of alcohol, tobacco, smoking.
- Always practice safe sex.
- Proper vaccination should be done.
OTHER PRECAUTIONS TO BE TAKEN
As the exact cause of the Castleman’s ss disease is not known, so it’s unclear how it can be prevented or what precautions should be taken if a person gets the disease. These are some points if followed can help reduce the risk of getting a CD. It includes:
- Protection from getting infected with human immunodeficiency virus (HIV) and human herpes virus-8 (HHV-8) by –
- Practicing safe sex( use condoms, dental dams)
- Do not share needles/syringes, shaving blades.
- Consider male circumcision.
- Get tested for STD’s including HIV, for getting early treatment for respective disease or infection.
- If pregnant, get medical treatment as early it is possible.
- Preexposure prophylaxis (PrEP) drugs should be used to reduce the risk of getting STD. It includes a combination of drugs emtricitabine plus tenofovir and emtricitabine plus tenofovir alafenamide
- Get vaccinated for the prevention of many ailments.
- Maintain hygiene.
- Avoid alcohol, smoking.
- Maintain healthy body weight.
Castleman tumor or disease rarely occurs and UCD is treated by surgical removal and MCD by therapeutic approach. The use of herbs to arrest the carcinogenic process by anti-proliferation action and inhibiting apoptosis is an alternative to treatment by allopathic medicine. Many herbal remedies, crab care pack is beneficial in treating CD by exhibiting tumouricidal properties in various cancers.
1. Is Castleman’s tumor cancer?
- In Castleman’s tumor, there is an enlargement of lymph nodes which is also overgrowth of cells, but it’s not cancer. It increases the risk of getting lymphoma which is a can of the lymphatic system.
2. Is it possible to cure Castleman’s tumor?
- Unicentric Castleman disease is cured by surgical removal of the involved lymph node in the majority of patients or medication can use to shrink the enlarged lymph node. Also, radiation therapy is effective in destroying the affected lymph node. Multicentric Castleman disease is treated with medication only.
3. Is Castleman’s tumor genetic?
- The exact cause of Castleman’s tumor is not known and it is not necessary to have a family history. But the person suffering from HIV/AIDS and HHV-8 virus are more likely to get this disease.
4.what are the prevention measures for Castleman’s tumor?
- As the exact cause of Castleman’s tumor is unknown, so the prevention is also not clear. Protection from HIV and HHV8 virus infection should be done to reduce the risk of getting Castleman’s tumor.
5. Can liver disease cause swelling of lymph nodes?
- Not all liver diseases but in Hodgkin lymphoma lymph nodes enlargement is seen without any known reason and it can spread to the nearby lymph nodes. In later stages, it may spread to multiple organs and areas.
6. How Castleman disease affect the body?
- Castleman disease is the disease that leads to enlargement of the lymph nodes which is a part of the defense mechanism to prevent the body from various infections.
- Charak Samhita –by Brahmanand Tripathi
- Sushrut Samhita – by Dr. Ambika Dutt Shastri
- Ashtang hridyayam – by Brahmanand Tripathi
- Dravyaguna vijnan – by Privrat Sharma
Dr. Vikram Chauhan (MD-Ayurvedic Medicine) is an Expert Ayurveda Consultant in Chandigarh (India). He has vast experience of herbs and their applied uses. He has successfully treated numerous patients suffering from various ailments, throughout the world. He is CEO and Founder of Krishna Herbal Company and Planet Ayurveda in Chandigarh, India. He researched age old formulas from ancient Ayurvedic text books to restore health and save human beings from the worst side-effects of chemical-based treatments.